Steroid joint injections

Steroid injections can reduce inflammation and ease pain in your joints. This will allow you to move more easily. You might have a steroid injection if you have a painful or swollen joint, including your knee, hip, shoulder, elbow, hand or wrist.

About steroid injections

Steroid medicines are also known as corticosteroids. They are a type of medicine that works by reducing inflammation in your body. This can help if you have swelling and pain.

How steroid injections work

A doctor will inject a steroid injection directly into a painful or swollen joint or into the soft tissue around it. Inside the joint, steroids act against substances that cause inflammation and damage your tissues. A steroid injection into the injured area can also release pressure, which helps with pain and swelling.

There are several different steroid medicines that are used for joint injections. Steroid injection names include:

• hydrocortisone
• methylprednisolone
• triamcinolone

Methylprednisolone and triamcinolone are stronger than hydrocortisone.

Where to get a steroid injection

Your GP may be able to give you a steroid injection at your local practice. Or they may refer you to a radiologist to do the injection using ultrasound or X-rays (fluoroscopy) to guide them to exactly the right place. A physiotherapist, rheumatologist, orthopaedic surgeon or nurse may give you a steroid injection in a clinic or hospital. Steroid injections can only be given by healthcare professionals who are trained to do these procedures.

How steroid injections can help

Steroid injections may not cure the underlying problem or condition that affects your joint. But they may ease your symptoms. They’re often used alongside other treatments such as other medicines and physiotherapy. If you’re having physiotherapy, steroid injections may allow you to cope with it better and get more out of it.

Some steroid injections start to work within a few hours and last for around a week. Others take up to a week to start working, but then last for a couple of months or more. Sometimes, depending on what’s caused the inflammation, the injection may be enough to completely fix the problem. Generally, it’s best not to have more than four steroid injections per year into any one joint. This is because there’s a chance any more than that could damage your joint.

Uses of steroid injections

Steroid injections can be used in many different conditions that affect your joints, including:

• rheumatoid arthritis
• other types of inflammatory arthritis – for example, psoriatic arthritis
• gout
• osteoarthritis
• tennis or golfer’s elbow
• carpal tunnel syndrome
• shoulder problems – for example,frozen shoulder or rotator cuff injury

Your doctor or other health professional may offer you a steroid injection if your joint pain has got worse, and other treatments haven’t helped. It can help as a short-term treatment to deal with severe pain or while you wait to start longer-term treatment.

Preparation for a steroid injection

Your doctor or healthcare professional will discuss with you what to expect from a steroid injection. If you’re unsure about anything, just ask. You’ll need to give your consent before having the injection, so it’s important to make sure you feel fully informed.

Let the health professional who’s going to treat you know if any of the following apply to you.

• You take a medicine that thins your blood. This includes anticoagulants such as warfarin. These increase your risk of bleeding into the joint. You may need to have a blood test first to check how well your blood clots.
• You have a health condition that affects the way your blood clots – for example, haemophilia. This can increase your risk of bleeding into the joint.
• You have diabetes. This is because a steroid joint injection may raise your blood sugar for several days afterwards.
• You have high blood pressure. Steroid injections can increase blood pressure.
• You have an allergy to steroids or local anaesthetic.
• You have a skin infection or infection in the affected joint.
• You’re pregnant or breastfeeding. Steroid injections aren’t considered to be harmful if you’re pregnant or breastfeeding. But it’s still best to let the health professional know.

You don’t usually need to make any special preparations before having a steroid injection. But it’s best to wear comfortable clothes that allow easy access to the joint that will be injected.

It can be difficult to drive immediately after the injection, so arrange for friends or family to drive you home if possible. Also, be prepared to rest the affected joint for a few days afterwards.

The steroid injection procedure

Your doctor or other health professional will examine your joint and clean your skin with an antiseptic.

They may give you a local anaesthetic with a steroid injection. This will stop any pain that you may have during the injection. Your doctor or healthcare professional may inject the local anaesthetic into your skin before the steroid. Or, they may mix it with the steroid in a single injection.

They’ll inject the medicines into the inflamed area of your joint. For certain joints, your doctor or healthcare professional may use ultrasound during the procedure to help guide the needle into the right spot. You may feel a tightness or pressure when you have the injection.

Sometimes, your doctor or health professional may remove (aspirate) any fluid in the joint during the same procedure. They’ll use a syringe to do this. It can make your joint more comfortable, particularly in the case of swollen knees.

Aftercare following a steroid injection

If you have a local anaesthetic, the pain in your joint will ease within a few minutes. The effects of the local anaesthetic may last for a couple of hours, sometimes more. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may need to wait at the practice or clinic for a short time, to make sure you feel OK. This will usually be for around 10 to 15 minutes. Once you feel ready, you’ll be able to go home. It’s usually best if a friend or family member can drive you.

Recovery from a steroid injection

As the local anaesthetic wears off, the pain in your joint may initially be worse than before you had the injection. This pain is due to inflammation caused by the injection itself. It may last for a day or two. The following tips may help you manage the pain.

• Put ice or a cold compress on the area. This can reduce swelling and bruising. Don’t put ice directly on your skin – always wrap it in a towel first. Don’t put a cold compress or wrapped ice on your skin for more than 20 minutes at a time.
• Take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask a pharmacist for advice.
• Rest your joint for a day or two at least. Be careful not to do too much with your joint for the first couple of weeks.

It can take up to a week for the steroid injection to start working and ease your pain. Your health professional may give you some gentle exercises to do. You can slowly build these up as your symptoms improve.

Side-effects of steroid injections

Side-effects are the unwanted but mostly temporary effects that you may get after having a treatment. Side-effects of steroid injections include the following.

• Increased pain and swelling in the injected area. This usually settles within a couple of days. For information on how to manage the pain, see our section on recovery from a steroid injection.
• Feeling hot or having a flushed or red face. This usually happens straight after the injection and goes away within a few hours. Occasionally, it may start the day after the injection and carry on for a few days.
• If you have periods, a steroid injection can temporarily affect them.
• Temporary problems with your blood sugar control and blood pressure. It’s important to pay extra close attention to your blood sugar levels after a steroid injection if you have diabetes or high blood pressure.
• Thinning or a change in the colour of your skin around the injection site. This tends to happen more often with stronger or repeated injections. It may improve with time but it can be permanent (although this is rare).
• Changes in your mood – you may feel very high or very low. This is more likely if you tend to get problems with your mood.

Complications of steroid injections

Complications are when problems occur during or after the procedure. Serious complications are rare with steroid injections. But they include the following.

• An infection within the joint or in the tissues surrounding it. If the pain in your joint suddenly gets worse or your joint feels hot as well as painful, seek urgent medical advice.
• Damage to your joint or the ligaments or tendons around it. This is more likely the more injections you have. This is why there’s guidance about how often you can have steroid injections.

Ask your doctor or healthcare professional to explain how these risks may apply to you.

Alternatives to a steroid injection

If you can't have or don't want a steroid injection, there are other ways to manage your pain. What treatment you’re offered will depend on your individual circumstances, including what’s causing your pain. Alternatives include:

• steroid tablets
• anti-inflammatory and painkilling medicines
• physiotherapy

Ask your doctor about the options available to you.